Please indicate the reason you are requesting a replacement for your SMC ID badge

Name Change Information

Please enter former name in the spaces provided below

Previous Legal Last Name *

Previous Legal First Name *

Previous Middle Initial(s) *

Other Details

Replacement Reason Other *

Please indicate why you are requesting a new badge.

Employee Dept--Title Change Information

New Department *

New Title *

Role Details

Employee Role Specifics *

Administration

Faculty

Staff

Indicate primary role at Southwestern Michigan College.

Birth Date *

Month

Day

Year

Former SMC Student or Employee? *

Yes

No

Unknown

Has the badge recipient ever previously attended or worked at SMC?

Former Name

Enter former or maiden name badge recipient had while attending Southwestern Michigan College, if different than legal name provided above.

Educational Partner Photo Upload

If the badge recipient is unable to visit SMC during regular office hours to have their badge photo taken, a photo may be uploaded using the interface provided above.Files must be less than 2 MB.Allowed file types: jpg jpeg png tif.

Emergency Personnel Employment Status *

Active

Reserve

Retired

Emergency Personnel Title *

Contractor Company Name *

Please enter the name of the badge recipient's business in the space provided above.

Contractor Title *

Please enter the badge recipient's title in the field provided above.

Employee Spouse Membership Information

Employee Name *

Please provide the name of the employee who is the spouse of the applicant.

Housing Resident Information

Housing Resident *

Yes

No

Residence Hall *

Not Assigned

Jerdon Hall

McKenzie Hall

White Hall

If the student have been assigned to a room in student housing building, please select the building from the list above or select Not Assigned.